I.J.E van der Meulen1, C.P. Nieuwendaal1,

Slides:



Advertisements
Similar presentations
Post-Mortem Ultra-Structural Analysis of a Cornea Transplanted With DMEK Jack Parker Jr, MD; Eitan Livny, MD; Vasilis S. Liarakos, MD, PhD; Gerrit R. Melles,
Advertisements

Writing Committee for the Cornea Donor Study Research Group
Comparison of Endothelial Cell Count by Manual and Automated Methods in Normal Corneas and in Fuchs' Endothelial Dystrophy Somasheila I Murthy, Debarun.
The authors have no financial interests to disclose
Retrospective comparison of staged versus combined cataract surgery and Descemet’s-stripping endothelial keratoplasty (DSEK) in patients with Fuchs’ Dystrophy.
Katsuya Yamazoe, MD, Takefumi Yamaguchi, MD, Kazuki Hotta, MD, Yoshiyuki Satake, MD, Kenji Konomi, MD, Seika Den, MD, Jun Shimazaki, MD Presented by: Abdulrahman.
Relationship Between Donor Graft Cell Count and Visual Outcome in DSAEK Patients Authors Silvin Bakalian MD PhD, Johanna Choremis MD FRCSC, Michele Mabon.
V. S. Liarakos, K. van Dijk, L. Ham, L. Baydoun and G.R.J. Melles Anterior Chamber vs Posterior Chamber IOL in DMEK for Pseudophakic Bullous Keratopathy.
Department of Ophthalmology, University Hospital Ayr, Scotland
Jeffrey J. Ing, MD, FACS, (Delta Eye Medical Group, Loma Linda University School of Medicine, Department of Ophthalmology) Thanh T. Nguyen, OD (Delta Eye.
Corneal Densitometry and Visual Outcome Comparisons of DSAEK and DMEK Eyes Xiaolin Zhang MD Robert L. Schultze MD Robert A. Eden MD Rahul Raghu.
DESCEMETIC DALK AND PREDESCEMETIC DALK : OUTCOMES IN 44 CASES DR. NITESH NARAYEN CORNEA AND REFRACTIVE SURGEON MAXIVISION HYDERABAD THE AUTHOR HAS NO FINANCIAL.
Ruth Lapid-Gortzak MD PhD 1,2, Jan Willem van der Linden BOpt 2, and Ivanka J. van der Meulen MD 1,2 1 Department of Ophthalmology, Academic Medical Center,
Elvin H. Yildiz, Elisabeth J. Cohen, Ajoy S. Virdi, Kristin M. Hammersmith, Peter R Laibson, and Christopher J. Rapuano Cornea Service, Wills Eye Institute,
Hemi-Automated Lamellar Keratoplasty (HALK) Leonard Yuen, MD MPH MRCOphth Jodhbir Mehta, FRCS FRCOphth Li Lim, FRCOphth Donald Tan, FRCS FRCOphth SINGAPORE.
Bryan Y Kim 1, Shintaro Kanayama MD PhD 1, Tueng T Shen MD PhD 1, Thomas E Gillette MD 2 1 University of Washington Department of Ophthalmology, 2 Eye.
Dr. K.S.SIDDHARTHAN Aravind Eye Hospital Coimbatore
Somasheila I. Murthy, Prashant Garg, Pravin K. Vaddavalli
Dept. of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. Outcome after big-bubble deep anterior lamellar keratoplasty.
Evaluation of Corneal Parameters and Spherical Aberration After DSAEK Measured with Pentacam System Orkun Muftuoglu, Pawan Prasher, R. Wayne Bowman, Steven.
Evaluation of Interface Reflectivity and Corneal Aberrations following DSAEK Hamid Khakshoor, MD Professor of Ophthalmology Mashhad University of Medical.
Quality of Vision in Patients With Fuchs Endothelial Dystrophy and After Descemet Stripping Endothelial Keratoplasty van der Meulen IJE, Patel SV, Lapid-Gortzak.
Postoperative Visual Acuity in Patients With Fuchs Dystrophy Undergoing Descemet Membrane–Stripping Automated Endothelial Keratoplasty: Correlation With.
Anterior Segment Optical Coherence Tomography and In Vivo Confocal Microscopy Findings in Femtosecond Laser- Assisted Keratoplasty Kurt H. Kelley, MD;
Descemet Stripping Automated Endothelial Keratoplasty in patients with Toxic anterior segment syndrome induced endothelial failure First and Presenting.
Epithelial Ingrowth Following Endothelial Keratoplasty Ritika Dalal, DNB Robert S. Feder, MD, Irving Raber, MD, Steven P. Dunn, MD, Robert Weisenthal,
Endothelial Keratoplasty in Patients With an Anterior Chamber Intraocular Lens: A Montreal Experience Georges M. Durr, MD 1,2 Johanna Choremis, MD, FRCSC.
Clinical outcome of DALK in Keratoconus – A one year follow up
Copyright restrictions may apply JAMA Ophthalmology Journal Club Slides: Thickness and Asymmetry After DSAEK Dickman MM, Cheng YYY, Berendschot TTJM, van.
Descemet Stripping Automated Endothelial Keratoplasty with a Graft Insertion Device : Technique and Early Results Dr Wei-Boon KHOR, MRCS(Ed), Dr Jodhbir.
Descemet-Stripping Automated Endothelial Keratoplasty Grafts Prepared from Endothelial Side Using a 500 kHz Femtosecond Laser: Six-Month Outcomes Jesper.
Successful Use of Corneal Tissue from LASIK Donors in Descemet-Stripping Automated Endothelial Keratoplasty: A Case Series Mark D. Mifflin, MD Majid Moshirfar,
Daniel D. Hayes, MD1; Carolyn Y. Shih, MD1; David C
Risk Factors and Outcomes of Donor Lenticule Dislocation Following DSEK Pravin K Vaddavalli MD, Suntia Chaurasia MD, Muralidhar Ramappa MD, Prashant Garg.
Deep Anterior Lamellar Keratoplasty (DALK) Vs Penetrating Keratoplasty (PK) in patients with Keratoconus (KC). Dr. K.S.SIDDHARTHAN Aravind Eye Hospital.
Comparison of Central Corneal Thickness, Anterior Chamber Depth, and Central Corneal Power Measurements between Two Scheimpflug Imaging Systems Yuichi.
DSEK for the treatment of endothelial disease in India -Initial Experience in 80 eyes- Authors have no financial interest Dr Ashish Nagpal MD, FRCS Dr.
Comparison of Endothelial Keratoplasty (EK) Visual Outcomes with OCT Derived Corneal Thickness Measurements Authors Abraham K. Sleem, MD Robert L. Schultze,
Descemet’s stripping automated endothelial keratoplasty by novice endothelial keratoplasty surgeons Jason W. Much, M.D. 1 Paul M. Phillips, M.D. 1,2 Leslie.
The authors have no conflicting interest in the subject matter of this poster. In Vivo Evaluation of DSAEK Interface with Scanning- Laser Confocal Microscopy.
Predicting Visual Acuity after Descemet’s Stripping Endothelial Keratoplasty using Corneal Topography, Pachymetry and Posterior Curvature Asymmetry Indices.
Descemet’s Stripping Endothelial Keratoplasty (DSEK) in patients with prior Trabeculectomy or Tube shunt surgery. Thadani S.M. Fynn-Thompson N. Authors.
Simulated Experiments on IOL Power Calculation Using Anterior Segment OCT Dong Hyun Jo, M.D., 1,2 Mee Kum Kim, M.D., 1,2 Won Ryang Wee, M.D. 1,2 1 Department.
Liquifaction Method and Extent of Posterior Capsule Opacification: Two-Year Follow-up Marie Kalfertova, Mariya Burova, Pavel Rozsival, Nada Jiraskova Nada.
Corneal Endothelial Cell Changes After LASIK Using a Femtosecond Laser Minoru Tomita, MD, PhD, Masaru Aoyama, MD, Minoru Tomita, MD, PhD, Masaru Aoyama,
CORNEAL ENDOTHELIAL PROFILE AFTER FERRARA RING IMPLANTATION Leonardo Torquetti, MD, PhD Paulo Ferrara, MD, PhD Paulo Ferrara Eye Clinic Belo Horizonte.
Effect of Donor Processing and Storage Time and Preoperative Endothelial Cell Counts on DSAEK Detachment Rates Daniel Demsey BScE Stephanie Baxter MD,
Date of download: 9/18/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Quality of Vision in Patients With Fuchs Endothelial.
Varsha Rathi DO, P K Vaddavalli MS, S Murthy MS, V S Sangwan, MS
cross- sectional analyses of HEIJO-KYO Cohort
Analysis of Macular Edema after Cataract Surgery in Patients with Diabetes Using Optical Coherence Tomography  Stephen J. Kim, MD, Robert Equi, MD, Neil.
IOP control and corneal endothelial cell density changes
Outcomes and Complications of DSEK in Eyes with Tube shunts or ACIOLs
Martha Jaimes Gutierrez M.D Alexandra Abdala Figuerola M.D.
Influence of UVA-Riboflavin corneal collagen cross-linking on biomechanical properties of keratoconic eyes David Zadok MD, Yakov Goldich MD, Yaniv Barkana.
Copyright © 2013 American Medical Association. All rights reserved.
Study of Death to Preservation Time and
Endothelial keratoplasty in failed grafts
Kyoto Prefectural University of Medicine
Early Experience with Descemet’s Stripping Automated Endothelial Keratoplasty Combined with Phacoemulsification: Clinical and Refractive Outcome University.
Model of Hyperopic Shift After DSEK
Hong A, Boehlke CS, Afshari NA, Kim T Duke University Medical Center
Eric Dai MD, Pawan Prasher MD, James McCulley MD, R. Wayne Bowman MD.
Three-Year Follow-up after LASIK in Eye with Extremely Thin Corneal Bed Hidemasa Torii, MD, Kazuno Negishi, MD, Murat Dogru, MD, Takefumi Yamaguchi, MD,
Michael R. Banitt, MD, João Baptista Malta, MD, Roni M
Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty Neelofar Ghaznawi MD, Melissa B Daluvoy MD, Ajoy Virdi MD, Edwin S Chen, Kristin.
Role of HSV Infection in the Histopathology of Failed DSAEK
Figure 4 Relationship of thickness of retinal layers to quality of life and low-contrast visual acuity Scatter plot and fitted linear regression line showing.
Anand K Shah MD1 Neda Shamie MD1 Paul Phillips MD1 Mark A Terry MD1,2*
University of Texas Southwestern Medical Center at Dallas, Texas
Presentation transcript:

Straylight and long term follow-up after Descemet stripping endothelial keratoplasty (DSEK) I.J.E van der Meulen1, C.P. Nieuwendaal1, R. Lapid-Gortzak1, T.J.T.P van den Berg2 1 Department of Ophthalmology, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands 2 Netherlands Institute for Neuroscience, Netherlands Royal Academy, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands The authors have no financial interest in the subject matter of this poster

Background Forward light scatter causes straylight and disability glare which can be measured by the Oculus C-Quant, using the compensation comparison method. This is a psychophysical test, resulting in the straylight parameter s. Usually log(s) is used.

Background Log(s) shows a physiological increase with age. Disturbances to optical media, like corneal thickening in Fuchs’ endothelial dystrophy, lead to reduced quality of vision through increased straylight. The effect of DSEK on straylight values is still unclear. Normal values of log(s) adjusted for age with 95% confidence intervals 0.3 log(s) increase = 2x increase in straylight 1.0 log(s) increase = 10x increase in straylight

Purpose To report long term (6 months to 5 years) postoperative outcomes of DSEK. To correlate the clinical characteristics of the cornea with quality of vision as evaluated by best corrected distance visual acuity (BCDA) and straylight values.

Methods 34 eyes of 26 patients were included which had undergone DSEK between March 2003 – May 2008 for Fuchs’ endothelial dystrophy. In a previous study performed in July 2006 some of the same eyes were measured. (Nieuwendaal et al., Cornea, 2009) Data from this study (BCDA, corneal pachymetry and endothelial cell density) were used for comparison with the present study.

Methods Examinations: Best corrected distance visual acuity (BCDA) Straylight measurements using the Oculus C-Quant Semi-quantitative slitlamp grading of interface and stromal changes (0 = normal, 5 = diffusely dense corneal opacification with corneal edema and descemet folds) Corneal pachymetry of total cornea, recipient cornea and donor disc with anterior segment OCT ( Visante AS-OCT) Endothelial cell density (ECD) using Topcon Subjective complaints were documented with the NEI-VFQ-39 questionnaire and a straylight questionnaire

Results Parameter Present Average (±SD) Median (range) Number (n) Past Age (years) 72.1 ±11 72 (48 – 91) 26 patients 67.7 ±12 69.3 (45-82) 15 patients Visual acuity (logMAR) 0.33 ±0.19 0.34 (0 – 0.72) 33 eyes 0.27 ± 0.18 0.2 (0 – 0.8) 32 eyes Straylight (log(s)) 1.47 ± 0.19 1.49 (1.07 – 1.78) 34 eyes n.a. Postoperative time (days) 1027 ± 453 936 (189 – 1921) 548 ± 311 561 (90 – 1046) 19 eyes Endothelial cell density (cell/mm2) 994 ± 507 821 (535 – 2813) 31 eyes 1478 ± 378 1508 (909 – 2400) 18 eyes Interface grade (0-5) 0.85 ± 1.08 1 (0 – 4) Stromal grade 0.18 ± 0.46 (0-2) Endothelial grade (0-5) 0.50 ± 0.56 Total cornea grade 1.53 ± 1.27 asOCT total at centre (μm) 609 ± 56 614 (494-722) 26 eyes 548 ± 43 533 (470 – 627) 14 eyes

Results 2 Straylight versus age: The central red line represents average straylight values of healthy pseudophakic eyes, which show a steady increase with increasing age. The two black lines represent ± 0.2 log intervals. Straylight values in DSEK patients show a statistically significant (p < 0.001) average difference of 0.12 log units compared to straylight values of normal pseudophakic patients. Present BCDA versus past BCDA: BCDA results hardly changed with longer-term follow up after DSEK.

Results 3 BCDA versus straylight: Straylight values showed a statistical relationship with BCDA, although the relationship is not very strong (n = 33, r = 0.456, p = 0.008). Preoperative (given at the vertical axis, at x = 0), earlier postoperative and present postoperative ECD versus postoperative time: striking intra-operative and early postoperative cell loss. After 6 months stabilisation to an average of 14% endothelial cell loss per year (red line). Mean postoperative EC loss correlated with recipient ( P< 0.03) and donor age (P< 0.02)

Results 4 Also no statistical relation was found between ECD values and BCDA. BCDA correlated with total grade of corneal haze (r = 0.50, P < 0.01), whereas straylight did not (r = 0.27, P = 0.12). Mean score on the NEI-VFQ-39 questionnaire was 77/100 and mean score on the straylight questionnaire was 46/100, indicating mild to moderate visual impairment compared to normal subjects, mostly due to straylight. The NEI VFQ 39 questionnaire weakly correlated with BCDA, but not with other parameters, as did the straylight questionnaire. Corneal thickness measurements by asOCT (anterior segment optical coherence tomography) versus ECD: The lines connect points of the same patient. There exists no relation between ECD values and corneal thickness.

Discussion and conclusions Straylight after DSEK remains elevated compared to age-normal (pseudophakic) eyes. BCDA remains worse compared to normal eyes. No significant change in BCDA is found between 6 months and 5 years postoperatively after DSEK. Reduced quality of vision after DSEK might be caused by changes in the host cornea (e.g., subepithelial fibrosis) or by the graft-host interface, which probably increases forward light scatter. 1,2,3 1) Patel SV. Ophthalmology 2007;114:627-8. 2) Patel SV, McLaren JW, Hodge DO, Baratz KH. Am J Ophthalmol 2008;145:97-105. 3) Patel SV, Baratz KH, Hodge DO, et al. Arch Ophthalmol 2009;127:153-60.

Discussion and conclusions Few studies discuss long-term endothelial cell loss after DSEK. 4,5 In our population, ECD shows a significant decrease postoperatively, without any changes in corneal thickness or quality of vision as yet. If the ECD loss continues in this rate of 14% cell loss/year, in 4-5 years the average ECD will reach 500 cells/mm2. Problems with decreased quality of vision must be anticipated in future. 4) van Dooren BT, Mulder PG, Nieuwendaal CP, et al. Am J Ophthalmol 2007;144:471-3. 5) Lee WB, Jacobs DS, Musch DC, et al. Ophthalmology 2009;116:1818-30.